腓肠肌内侧头肌瓣在胫骨近端骨肉瘤保肢术中的应用

Medial head gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma

目的:探讨腓肠肌内侧头肌瓣在胫骨上段骨肉瘤保肢术中的应用及疗效。方法:回顾性研究2000年1月至2010年1月胫骨近端骨肉瘤行保肢治疗的患者65例,按照Enneking方法分期,Ⅱa期35例,Ⅱb期30例,其中男37例,女28例;患者年龄(17.0±6.5)岁。所有患者均行肿瘤切除后人工关节置换,其中行腓肠肌内侧头肌瓣转移者35例,未行肌瓣转移者30例。结果:本组病例术后都得到随访。行肌瓣转移组瘤段骨切除长度为(13.5±4.2)cm,手术时间为(150±45)min,出血量为(700±135)mL,伤口引流量为(500±200)mL。未行肌瓣转移组瘤段骨切除长度为(12.3±5.8)cm,手术时间为(135±37)min,出血量为(600±105)mL,伤口引流量为(450±250)mL。行肌瓣转移组手术时间明显长于未行肌瓣转移组(P<0.05),而术中出血量及术后伤口引流量两组之间差异无统计学意义(P>0.05)。行肌瓣转移组2例(5.7%)出现局部皮肤坏死,1例(2.9%)出现假体深部感染。未行肌瓣转移组3例(10.0%)患者出现伤口皮下积血、积液,4例(13.3%)出现伤口感染,1例好转,3例发展为假体深部感染。行肌瓣转移组术后局部并发症发生率低于未行肌瓣转移组(P<0.05)。根据Enneking等肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准,行肌瓣转移组功能评定优13例,良17例,中3例,差2例,优良率85.7%;未行肌瓣转移组功能评定优10例,良12例,中5例,差3例,优良率73.3%。行肌瓣转移组术后下肢功能评定优于未行肌瓣转移组(P<0.05)。结论:胫骨近端骨肉瘤切除的保肢手术中,采用腓肠肌肌瓣移位可修复软组织缺损,降低局部并发症,提高临床治疗效果。

Objective： To evaluate the efficacy of transposition of the medial gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma.Methods： From January 2000 to January 2010,65 patients [37 males,28 females;（17.0±6.5） years] suffering from the proximal tibial osteosarcoma had a limb-salvage operation.According to the Enneking staging system,35 patients were in stageⅡa,30 in stageⅡb.All of the patients underwent resection of the osteosarcomas and reconstruction of the bone defect by prothesis.Among them,there were 35 patients underwent the medial head of the gastrocnemius muscle flap transposition to reconstruct the soft tissues and the other 30 didn＇t.Results： All the patients were followed-up.In the group with the transposition of medial gastrocnemius muscle flap,the length of tumor bone resection was（13.5±4.2） cm,operation time was（150±45） min,intraoperative blood loss was（700±135） mL,and drainage volume was（500±200） mL.In the group without the transposition of medial gastrocnemius muscle flap,the length of tumor bone resection was（12.3±5.8） cm,operation time was（135±37） min,intraoperative blood loss was（600±105） mL,and drainage volume was（450±250） mL.There was significant difference in the operation time（P0.05） but no significant difference in the intraoperative blood loss and drainage volume（P0.05）.In the group with the transposition of medial gastrocnemius muscle flap,local skin necrosis occurred in 2 patients（5.7%）,and prosthesis deep infection occurred in 1（2.9%）.In the group without the transposition of medial gastrocnemius muscle flap,subctaneous hematocele,and effusion occurred in 3（10.0%）,wound infection occurred in 4（13.3%）,1 cured and the other 3 developed prosthesis deep infection.There was significant difference in the rate of local complications（P0.05）.According to the function assessment by the Enneking system,in the group with the transposition of medial gastrocnemius muscle flap,13 patients had excellent results,17 had good results,3 had fair results and 2 had poor results,with a satisfaction rate of 85.7%.In the group without the transposition of medial gastrocnemius muscle flap,10 patients had excellent results,12 had good results,5 had fair results and 3 had poor results,with a satisfaction rate of 73.3%.There was significant difference in function assessment between the 2 groups（P0.05）.Conclusion： The flap transposition of the medial head of the gastrocnemiusmuscle can reconstruct the soft tissue defect,decrease the local complication rate and improve the clinical outcomes of the limb-salvage for the proximal tibia osteosarcoma.